Medium-term outcomes of C3-6 laminoplasty for cervical myelopathy: a prospective study with a minimum 5-year follow-up
Medium-term outcomes of C3-6 laminoplasty for cervical myelopathy: a prospective study with a minimum 5-year follow-up
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DOI：
10.1007/s00586-011-1690-0
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发表时间：
2011-06-01
影响因子：
2.8
通讯作者：
Yoshikawa, Hideki
中科院分区：
文献类型：
--
作者：
Sakaura, Hironobu;Hosono, Noboru;Yoshikawa, Hideki
据报道，保留肌肉插入 C7 棘突的 C3-6 椎板成形术与术后轴性颈部疼痛频率的显着降低有关。然而，尚无前瞻性研究报告 C3-6 椎板成形术的中期结果。本研究的目的是阐明 C3-6 椎板成形术后的中期结果。受试者包括 31 名脊髓型颈椎病患者，他们接受了 C3-6 椎板成形术，保留了附着在 C2 和 C7 棘突上的所有双侧肌肉，并随访了 5 年。前瞻性收集临床和放射学数据。使用日本骨科协会（JOA）评分评估神经系统状态。轴颈痛分为重度、中度或轻度。通过比较连续的侧位X光片来评估颈椎的矢状排列和后纵韧带（OPLL）骨化的进展。平均 JOA 评分从术前的 10.6 显着改善至最大恢复时的 14.7，并在最终随访时略有下降至 14.3。在六名晚期病情恶化的患者中，这些情况与颈椎无关。截至最终随访，仅 1 名患者（3.2%）主诉持续 5 年的轴性颈痛。尽管 63.6% 的患者发现后纵韧带骨化 (OPLL) 进展，但没有人因这种进展而出现神经功能恶化。在最后的随访中，颈椎的矢状排列比手术前更加前凸。 C3-6椎板成形术的中期结果令人满意。术后5年，持续性颈部轴性疼痛和颈椎前凸丧失的频率仍显着降低千分之一。
C3-6 laminoplasty preserving muscle insertions into the C7 spinous process is reportedly associated with a significantly decreased frequency of postoperative axial neck pain. However, no prospective study has reported medium-term outcomes of C3-6 laminoplasty. The purpose of this study was to elucidate medium-term outcomes after C3-6 laminoplasty. Subjects comprised 31 patients with cervical myelopathy who underwent C3-6 laminoplasty preserving all bilateral muscles attached to the C2 and C7 spinous processes and were followed for a parts per thousand yen5 years. Clinical and radiological data were prospectively collected. Neurological status was assessed using Japanese Orthopaedic Association (JOA) score. Axial neck pain was graded as severe, moderate or mild. Sagittal alignment of the cervical spine and progression of ossification of the posterior longitudinal ligament (OPLL) were assessed by comparing serial lateral radiographs. Mean JOA score improved significantly from 10.6 before surgery to 14.7 at the time of maximum recovery, and slightly declined to 14.3 at final follow-up. In six patients who developed late deterioration, these conditions were unrelated to the cervical spine. As of final follow-up, only one patient (3.2%) had complained of axial neck pain persisting for 5 years. Although progression of OPLL was found in 63.6% of patients, none had experienced neurological deterioration due to this progression. At final follow-up, sagittal alignment of the cervical spine was more lordotic than before surgery. Medium-term outcomes of C3-6 laminoplasty were satisfactory. Frequencies of persistent axial neck pain and loss of cervical lordosis after surgery remained significantly decreased for a parts per thousand yen5 years postoperatively.